What is accident cover and how does it work?


3 minutes

26 June 2020

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Last updated:

If you had a crystal ball that predicted every mishap and accident before it happened – and maybe the winning lottery numbers – you might not need health insurance to cover you for accidents.

But life doesn't always work out that way, and health insurance can play an important role in protecting your number one asset in life – your health. If you are young and healthy, you might not need a Gold Hospital Elevate policy, but it could still make a lot of sense to have cover for accidents.

What is accident cover?

Accident cover helps pay for treatment you receive if you’re admitted into hospital as a result of an accident. It’s a feature on some private hospital covers, so it applies when you’re admitted to a hospital as a private patient. At HBF, accident cover is included on Basic Hospital Plus and Basic Hospital Plus Elevate covers.

HBF defines an accident as

An unforeseen event, occurring by chance and caused by an external force or object which results in an injury to the body requiring admission to Hospital for medical treatment.

In layman’s terms an accident could be falling off your bike, getting tackled during a footy match, or slipping on water and you need to be hospitalised to treat the injury.

Just for clarity, any illness or condition that develops over time, like heart disease or osteoporosis, would not be considered an accident.

If I have an accident, what is covered?

If you have HBF's Basic Hospital Plus or Basic Hospital Plus Elevate you’ll be covered for treatment if you are admitted into hospital resulting from an accident – even if the treatment you need is not an included service on your policy.

For example, a knee replacement is excluded on Basic Hospital Plus and Basic Hospital Plus Elevate but if you require knee replacement surgery as a result of an accident, you’d be covered for the treatment.

This also means you can choose a private hospital for your treatment. You’ll potentially avoid a long public hospital waiting list and enjoy all the perks of private hospital treatment.

Here is what HBF members are entitled to for agreed services at a Member Plus hospital:

  • Cover for your own private room, subject to availability
  • Fully covered for theatre fees
  • Prostheses
  • In-hospital pharmacy
  • Cover for hospital boarders

Remember though, accident cover only pays benefits for treatment you receive while admitted into hospital. This means that other costs like GP visits or visits to the emergency department won’t be covered.

Normal rules for medical gap benefits apply. You can call us on 133 423 for more information.

How do I use accident cover?

For a benefit to be paid under accident cover for hospital treatment after an accident the following criteria must be met. 

  • You’ve served the one-day waiting period. You don't have to wait for long to access accident cover on Basic Hospital Plus or Basic Hospital Plus Elevate. There is a one-day waiting period, which means you can't claim on the same day you take out the cover, but if you do happen to have an accident the next day, you're all good.
  • Your payments are up to date. You will also need to make sure your premium payments are up to date on the day of your treatment, your policy cannot be in arrears.
  • You make an initial medical presentation within seven days. You must be seen by a Medical Practitioner or admitted to hospital for medical treatment within seven days of the accident.
  • You’re admitted to hospital for treatment within 90 days. If your doctor says you need to be admitted into hospital for treatment as a result of the accident, you must be admitted to a hospital for the initial and any subsequent treatment within 90 days of your initial medical presentation after the accident.
  • You complete an accident/injury report form. To help us process your accident claim for hospital treatment, you’ll need to complete an accident/injury report form to inform us about how the accident/injury occurred.

When can't I use accident cover?

There are a few scenarios where benefits may not be payable, for example, if your premium payments are not up to date when you get treatment, or if the accident occurred as a consequence of your employment.

Again, remember that accident cover only pays benefits for treatment you receive while admitted into hospital. This means that other costs like GP visits or visits to the emergency department won’t be covered.

Is accident cover right for me?

If you're looking for entry-level hospital cover that provides you with accident cover, Basic Hospital Plus offers just that. If you’re looking for a step up, you can consider Basic Hospital Plus Elevate which also has accident cover.

But before you decide on cover, make sure you consider your needs – not just the price tag. The best value cover for you is the one that caters to your needs.

If you're thinking about planning a family, need some peace of mind or have a few health concerns, we strongly recommend you chat with our friendly team to find the right cover for you.

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